Individual
JENNA BAZELON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
839 MOSELEY RD, HIGHLAND PARK, IL 60035-4635
(847) 745-5406
Mailing address
5150 GOLF RD, SKOKIE, IL 60077-1283
(847) 745-5406
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/21/2015
Last updated
12/21/2015
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